BENZODIAZEPINES

long term (> 30 days) use avoid abrupt cessation
drink in moderation and not in excess
CIV: I would give a 3 day supply if can't get a hold of the doctor
short acting vs long acting: short acting are the ones that are abused (xanax) than long acting
CNS effects- extreme dizziness to stop breathing when taken with alcohol
interaction w/St.John's Wort [CYP interaction it decreases the effectiveness of lorazepam]

PC: SSRIs

BBW: increase risk of suicide in children and adoloscents
signs of depression - withdrawing, talking down about themselves, lack of interest, irritability - let patients know or what to look for- some patients who take this find the confidence to commit suicide
Do not take MAOIs (selegiline) b/c of serotonin syndrome [ excess of serotonin in the blood, severe anxiety, hyperthermia, tachycardia, HTN]

PC; MACROLIDE

AZITHROMYCIN (ZITHROMAX)

PI; with or w/o food
TAKE ANTACIDS 2 HOURS AFTER TAKING ZITHROMAX
if you have liver problem don't take it
anticoagulants: SE could be increased b/c of zithromax
tell dr./dentist if going to have emergency care or surgery

PC: FLUROQUINOLONE

CIPROFLOXACIN (CIPRO)

TC: FLUROQUINOLONE ANTIBIOTIC

BBW: tendonitis and tendon rupture- all ages even more of a risk in elderly (> 60 y/o), patients taking corticosteroids and in patients w/kidney, heart and lung transplants
myasthenia gravis- may exacerbate muscle weakness in persons with mg so avoid use

PC: FLUOROQUINOLONE

LEVOFLOXACIN (LEVAQUIN)

TC: FLUOROQUINOLONE ANTIBIOTIC

BBW: tendonitis and tendon rupture is increased in all ages further risk in alder patients, patients taking corticosteroids, patients with kidney, heart, or lung transplants
myasthenia gravis- may exacerbate muscle weaknes in person should avoid use

DOXYCYCLINE (VIBRAMYCIN)

PI: with or w/o food, if stomach irritation eat
take antacids 2 hours after medication, multivitamin
drink plenty of fluids to avoid throat irritation
BCP MAY NOT WORK AS WELL USE BACK
NAUSEA AND VOMITING

NUVARING (ETHINYL ESTRADIOL AND ETONOFESTREL)

PC MONOPHASIC HORMAL CONTRACEPTIVE

if it has been less than 3 hours rinse it off in lukewarm water and reinsert but if it has been more than 3 hours insert a new one or don't insert it and menstrate

can have sex and use a tampon
needs to be refrigerated
changing from OCP - Nuvaring; insert ring use back up method for 7 days
as long as patients insert ring when menstrating then protected

miconazole nitrate (yeast infection) decreases effectiveness of BCP

DIRECTIONS TO INSERT RING:
wash hands and dry
choose a comfortable position (lying down, squatting, standing with one leg up)
hold ring between your thumb and index finger and press the opposite sides of the ring together
gently insert and push the folded ring into the vagina as far as comfortably possible
you don't have to have it in the exact position for it to work
you should not feel the ring once inserted if you doit is not inserted far enough into the vagina
if it comes out of place use finger to push back up you can not put it too far up vagina b/c cervix will block
should be left in for 3 weeks then removed

DIRECTIONS TO REMOVE THE RING
wash and dry hands
again find comfortable position
loop your finger through the ring and gently pull it out
discard ring in trash DO NOT FLUSH
wait 7 days before inserting a new ring

first time using contraceptive insert when menstrating and will be protected from then on

PC: BETA BLOCKERS

TC: ANTIHYPERTENSIVE

BBW: Ischemic heart disease; abrupt cessation of therapy may cause angina pectoris or MI when patients taper off over a period of 1-2 weeks even in patient with HTN d/c gradually
Major surgery: pt. should not d/c but PCP should know if do need to d/c 1-2 weeks taper off
Bronchospastic Dx: asthma COPD- caution and monitor w/use
DM & hypoglycemia: if experience low blood sugar but patient can't tell (shaky, tired, dizzy, confused, SWEATING only symptom that will be seen

should be advised to regularly and continuously take as directed with or immediately following meals or with meals [bioavailability ER, small intestine better absorption]
DO NOT D/C ABRUPTLY
hypotension: lightheadedness, dizziness, from a sitting to standing position- resolves (15-30 seconds) be careful getting up; driving car tasks requiring alertness
concomitant use of clonidine- stop beta-blocker 1st and then stop clonidine
depression and fatigue: 1st couple weeks patient doesn't feel well
ER TABLET: don't crush, swallow whole, no chewing, sometimes shell will be in the toilet

take 4 hours before next dose if missed dose or rule of thumb: take as soon as you remember as long as it is NOT the same day that they have taken another dose

TRIAMTERENE/HCTZ (MAXZIDE)

PC: POTASSIUM SPARING DIURETIC/THIAZIDE DIURETIC COMOBO

TC: DIURETIC

C?I: anuria and oliguria
PT INFO
sunlight
OTC products (appetite suppression and cough and cold)
sulfonamide allergy
hypotension
etoh intake
hydration
take with or w/o food; if stomach upset take WF
this medication will increase the amount of urination when 1st start taking take before 6pm so it will not disrupt patient sleep
hypokalemia- low K+
hypomagnesemia

FENOFIBRATE (TRICOR)

PC: FIBRIC ACID DERIVATIVE

HOW IT WORKS: helps decrease the amount of fatty substances in your blood and increase good cholesterol HDL, it works by speeding up the natural processes that remove cholesterol from the body
MOA: inhibits TG synthesis and stimulates HDL